1790927739 NPI number — AMEDISYS ILLINOIS LLC

Table of content: (NPI 1790927739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790927739 NPI number — AMEDISYS ILLINOIS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMEDISYS ILLINOIS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790927739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 S SHERWOOD FOREST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-6038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-292-2031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1830 2ND AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ROCK ISLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61201-8003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-786-5762
Provider Business Practice Location Address Fax Number:
309-786-7029
Provider Enumeration Date:
04/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BORNE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
225-292-2031

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 364576454003 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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